Physiological monitor gauge panel

ABSTRACT

A physiological monitor gauge panel defines parameters to display on a physiological monitor via corresponding gauges. Gauge faces depict a range of parameter values for each of the parameters. An indicator designates a position on each gauge face corresponding to the current parameter value within the range of parameter values. The indicated position on each of the gauges is at the mid-point of each of the gauge faces when each of the parameters is at a nominal value.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent application Ser. No. 13/663,457, filed Oct. 29, 2012, titled Physiological Monitor Gauge Panel, which claims priority benefit under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 61/552,427, filed Oct. 27, 2011, titled Physiological Monitor Gauge Panel; the above-cited applications hereby incorporated in their entirety by reference herein.

BACKGROUND OF THE INVENTION

Pulse oximetry is a widely accepted noninvasive procedure for measuring the oxygen saturation level of arterial blood, an indicator of a person's oxygen supply. A typical pulse oximetry system utilizes an optical sensor attached to a fingertip to measure the relative volume of oxygenated hemoglobin in pulsatile arterial blood flowing within the fingertip. Oxygen saturation (SpO₂), pulse rate and a plethysmograph waveform, which is a visualization of pulsatile blood flow over time, are displayed on a monitor accordingly.

Conventional pulse oximetry assumes that arterial blood is the only pulsatile blood flow in the measurement site. During patient motion, venous blood also moves, which causes errors in conventional pulse oximetry. Advanced pulse oximetry processes the venous blood signal so as to report true arterial oxygen saturation and pulse rate under conditions of patient movement. Advanced pulse oximetry also functions under conditions of low perfusion (small signal amplitude), intense ambient light (artificial or sunlight) and electrosurgical instrument interference, which are scenarios where conventional pulse oximetry tends to fail.

Advanced pulse oximetry is described in at least U.S. Pat. Nos. 6,770,028; 6,658,276; 6,157,850; 6,002,952; 5,769,785 and 5,758,644, which are assigned to Masimo Corporation (“Masimo”) of Irvine, Calif. and are incorporated in their entirety by reference herein. Corresponding low noise optical sensors are disclosed in at least U.S. Pat. Nos. 6,985,764; 6,813,511; 6,792,300; 6,256,523; 6,088,607; 5,782,757 and 5,638,818, which are also assigned to Masimo and are also incorporated in their entirety by reference herein. Advanced pulse oximetry systems including Masimo SET® low noise optical sensors and read through motion pulse oximetry monitors for measuring SpO₂, pulse rate (PR) and perfusion index (PI) are available from Masimo. Optical sensors include any of Masimo LNOP®, LNCS®, SofTouch™ and BIue™ adhesive or reusable sensors. Pulse oximetry monitors include any of Masimo Rad-8®, Rad-5®, Rad®-5v or SatShare® monitors.

Advanced blood parameter measurement systems are described in at least U.S. Pat. No. 7,647,083, filed Mar. 1, 2006, titled Multiple Wavelength Sensor Equalization; U.S. Pat. No. 7,729,733, filed Mar. 1, 2006, titled Configurable Physiological Measurement System; U.S. Pat. Pub. No. 2006/0211925, filed Mar. 1, 2006, titled Physiological Parameter Confidence Measure and U.S. Pat. Pub. No. 2006/0238358, filed Mar. 1, 2006, titled Noninvasive Multi-Parameter Patient Monitor, all assigned to Cercacor Laboratories, Inc., Irvine, Calif. (Cercacor) and all incorporated in their entirety by reference herein. Advanced blood parameter measurement systems include Masimo Rainbow® SET, which provides measurements in addition to SpO₂, such as total hemoglobin (SpHb™), oxygen content (SpOC™), methemoglobin (SpMet®), carboxyhemoglobin (SpCO®) and PVI®. Advanced blood parameter sensors include Masimo Rainbow® adhesive, ReSposable™ and reusable sensors. Advanced blood parameter monitors include Masimo Radical-7™, Rad87™ and Rad57™, Pronto-7® and Pronto® monitors, all available from Masimo. Such advanced pulse oximeters, low noise sensors and advanced blood parameter systems have gained rapid acceptance in a wide variety of medical applications, including surgical wards, intensive care and neonatal units, general wards, home care, physical training, and virtually all types of monitoring scenarios.

SUMMARY OF THE INVENTION

A physiological monitor gauge panel displays a graphical user interface (GUI) that allows medical care providers to quickly view and immediately and intuitively recognize and assess patient status across multiple parameters. The GUI comprises multiple gauges arranged in a panel. In an embodiment, a face of each gauge is configured as a circular portion. A needle of each gauge rotatably moves across the gauge face so as to indicate a parameter value. A gauge readout integrated with the gauge face also indicates a parameter value. An alarm region is disposed along at least one end of the face so as to indicate a lower alarm limit, an upper alarm limit or both lower and upper alarm limits. The alarm region becomes brightly illuminated when the needle is within the alarm region so as to alert a caregiver of an alarm condition.

In an embodiment, the physiological monitor gauge has a gauge face with generally semi-circular upper and lower edges defining downward-oriented ends and a mid-point between the ends defining an arced peak. Positions along the gauge face correspond to physiological parameter values. An indicator is disposed on the gauge face and is moveable along the gauge face according to a parameter value. The parameter value is displayed as at least one digit underneath the arced peak. The parameter type is specified under the parameter value.

One aspect of a physiological monitor gauge panel has a gauge face with generally semi-circular upper and lower edges. Each edge has downward-oriented ends and a mid-point defining an arced peak. Positions along the gauge face correspond to parameter values. An indicator is disposed on the gauge face and is moveable along the gauge face according to parameter values. At least one digit is displayed underneath the arced peak according to parameter values, and a parameter type is displayed under the at least one digit. In various embodiments, a generally arced color bar is disposed along the gauge face proximate at least one of the ends. The color bar defines an alarm region for parameter values. An arced histogram is disposed above the gauge face upper edge having bins, each of which generally represent parameter values corresponding to bin positions along the gauge face. Bin fills are depicted as relatively dark lines of various lengths coextending with particular ones of the bins. The bin fills each depict the amount of time the indicator persists at a given parameter value associated with a bin position.

Further aspect of a physiological monitor gauge panel are an alarm condition corresponding to the indicator positioned over the color bar. The gauge face changes from a generally neutral color to a red color during the alarm condition. Parameter value digits change from a black color to a white color during the alarm condition, and a background of the parameter value changes to a generally red color. A ghost face represents an unused quarter-circle region proximate one of the gauge face ends. A second generally arced color bar is located proximate the color bar and defines a cautionary region for parameter values. Gauge faces and corresponding indicators, parameter values and parameter types define a panel of parameter gauges. The indicators of each parameter gauge are generally centered at each of the arced peaks of the gauge faces so as to designate generally nominal values for the underlying physiological parameters. The panel displaying one or more significantly off-centered indicators signifies a potentially significant physiological event.

Another aspect of a physiological monitor gauge panel defines parameters to display on a physiological monitor via corresponding gauges. Gauge faces depict a range of parameter values for each of the parameters. An indicator designates a position on each gauge face corresponding to the current parameter value within the range of parameter values. The indicated position on each of the gauges is at the mid-point of each of the gauge faces when each of the parameters is at a nominal value. In various embodiments, gauge faces define a semi-circular range for each parameter. A low-range gauge has a left quarter-circle active face portion and a right quarter-circle inactive face portion. A high-range gauge has a right quarter-circle active face portion and a left quarter-circle inactive face portion. A high/low-range gauge has both a right quarter-circle active face portion and a left quarter-circle active face portion. A color bar designates an alarm region of parameter values. A second color bar designates a cautionary region of parameter values.

Yet another aspect of a physiological monitor gauge is a gauge face for depicting a range of values of a parameter on a physiological monitor. An indicator rotatably moves along the gauge face in response to the parameter so as to designate a current value for the parameter. The gauge face is configured so that the indicator is centered on the gauge face when the parameter current value is a nominal value. In various embodiments, the gauge face has a left-sided active face when the parameter has alarm limits for only low parameter values and a right-sided active face when the parameter has alarm limits for only high parameter values. The gauge face has both a left-sided active face and a right-sided active face when the parameter has alarm limits for both low parameter values and high parameter values. An active histogram is disposed proximate the active face for indicating the amount of time the indicator persists at a given parameter value. A virtual sliding knob sets the alarm limits along the gauge face.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a physiological monitor gauge panel illustration presenting nominal values for each parameter and dual (red and yellow zone) alarm limits;

FIG. 2 is a physiological monitor gauge panel illustration presenting less than nominal values for each parameter;

FIG. 3 is a physiological monitor gauge panel illustration presenting an alarm condition for a particular parameter;

FIG. 4 is a parameter gauge illustration presenting an active histogram;

FIG. 5 is a parameter gauge illustration presenting an alarm limit editor;

FIG. 6 is a parameter gauge illustration presenting a 3-dimensional edge;

FIG. 7 is a parameter gauge illustration presenting a visible needle indicator;

FIG. 8 is a quarter-circle parameter gauge illustration; and

FIG. 9 is a parameter gauge illustration presenting single (red zone) alarm limits.

FIG. 10 illustrates a block diagram of an exemplary embodiment of a patient monitoring system including a sensor and a multi-parameter patient monitor.

FIG. 11 illustrates a top elevation view of an exemplary handheld noninvasive multi-parameter patient monitor capable of displaying at least HbCO, such as, for example, the patient monitor of FIG. 10.

FIG. 12 illustrates an exemplary display of the patient monitor of FIG. 11.

FIG. 13 illustrates the display of FIG. 12 showing measured values of SpO₂, BPM, perfusion, and type of sensor according to an exemplary embodiment of the patient monitor of FIG. 10.

FIG. 14 illustrates the display of FIG. 12 showing measured values of HbCO, perfusion, and type of sensor according to an exemplary embodiment of the patient monitor of FIG. 10.

FIG. 15 illustrates the display of FIG. 12 showing measured values of SpO₂, HbCO, BPM, perfusion, and type of sensor, according to an exemplary embodiment of the patient monitor of FIG. 10.

FIG. 16 illustrates a top elevation view of an exemplary handheld noninvasive multi-parameter patient monitor capable of displaying at least HbCO and HbMet, such as, for example, the patient monitor of FIG. 10.

FIG. 17 illustrates an exemplary display of the patient monitor of FIG. 16.

FIG. 18 illustrates the display of FIG. 17 showing measured values of SpO₂, BPM, HbCO, HbMet, and type of sensor according to an exemplary embodiment of the patient monitor of FIG. 10.

FIG. 19 illustrates the display of FIG. 17 showing measured values of HbCO, HbMet, and type of sensor according to an exemplary embodiment of the patient monitor of FIG. 10.

FIG. 20A illustrates a perspective view of an exemplary noninvasive multi-parameter patient monitor such as, for example, the patient monitor of FIG. 10.

FIGS. 20B-20H illustrate display screens of the patient monitor of FIG. 20A.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 illustrates a physiological monitor gauge panel 100 embodiment configured as a GUI (graphical user interface) presented on a monitor display. The gauge panel 100 is depicted as displaying nominal values for each parameter, as described below. Advantageously, a GUI gauge panel presentation of physiological parameters allows medical care providers to quickly view and immediately and intuitively recognize and assess patient status across multiple parameters. Indeed, a familiarity with reading of electrical/mechanical needle gauges is acquired over a lifetime exposure to speedometers, thermometers, tachometers and fuel-level indicators, to name a few.

An exemplar gauge panel configuration displays three half-circle gauges including a SpO₂ (oxygen saturation) gauge 101, a SpHb (total hemoglobin) gauge 102 and a SpMet (methemoglobin) gauge 103. Each gauge has a semi-circular face 110 and a parameter value indicator 120 that rotatably travels along each face 110. In particular, each indicator 120 is a visible tip terminating an apparent (unseen) needle that extends from, and rotatably pivots around, a gauge center. See, e.g., FIG. 7, below, illustrating visible needle. The indicator 120 position on the face 110 matches the value of a digital parameter readout 140 of the indicated parameter value. Advantageously, each gauge 101, 102, 103 is configured so that the indicator 120 is at the face mid-point, i.e. straight up as depicted, when the parameter is at a nominal value. In this manner, a caregiver will immediately recognize a patient having one or more abnormal readings and the degree of abnormality across multiple parameters.

As shown in FIG. 1, a low-range-alarm gauge 101 is configured for parameters having alarm limits for only low parameter values. A high-range-alarm gauge 103 is configured for parameters having alarm limits for only high parameter values. A high/low-range-alarm gauge 102 is configured for parameters having alarm limits for both low and high parameter values.

Also shown in FIG. 1, a low-range-alarm gauge 101 embodiment is configured with a left quarter-circle active face 112 depicting a possible range of parameter values. A right quarter-circle inactive face 114 is unused. In an embodiment, the inactive face is depicted as a ghost face, e.g. with a thin or light outline, as shown. In other embodiments, the inactive face is not shown, i.e. the gauge 101 has a quarter-circle face, as described with respect to FIG. 8, below. An alarm region is designated by a curved color bar 150 proximate a low-value range 112 of the face 110. A numerical indicator 152 indicates the maximum value of the alarm region. In an embodiment, the color bar 150 is red. In an embodiment, a second color bar 170 indicates a cautionary region. In an embodiment, the second color bar 170 is yellow.

Further shown in FIG. 1, a high-range-alarm gauge 103 embodiment is configured with a right quarter-circle active face 114 depicting a possible range of parameter values. A left quarter-circle inactive face 112 is unused. In an embodiment, the inactive face is depicted as a ghost face 190 as shown. In other embodiments, the inactive face is not shown. An alarm region is designated by a curved color bar 160 (e.g. red) proximate a high-value range 114 of the face 110. A numerical indicator 162 indicates the minimum value of the alarm region. In an embodiment, a second color bar 180 (e.g. yellow) indicates a cautionary region.

Additionally shown in FIG. 1, a low/high-range-alarm gauge 102 embodiment is configured with a semi-circle active face 112, 114 depicting a possible range of parameter values. A left quarter-circle active face 112 illustrates high range values and a right quarter-circle active face 114 illustrates low range values. Alarm regions are designated by a curved (red) color bars 150, 160 at the high and low parameter ranges, respectively. Numerical indicators 152,162 indicate the alarm onset regions. In an embodiment, a second (yellow) color bars 170, 180 indicates cautionary regions. In an embodiment, the parameter value indicator 120 is a brightly illuminated white.

FIG. 2 illustrates a physiological monitor gauge panel 200 presenting less than nominal values for each parameter. In particular, each gauge 101, 102, 103 has an indicator located away from a vertical (straight-up) position, as compared with the panel 100 (FIG. 1), described above. Advantageously, the off-vertical indicators 120 immediate signal a caregiver of one or more abnormal readings and the degree of abnormality across multiple parameters.

FIG. 3 illustrates a physiological monitor gauge panel 300 presenting an SpHb parameter gauge 101 that indicates an alarm condition. In particular, the gauge indicator 120 and readout 140 indicate SpHb has dropped below a listed limit of 7. In an embodiment, the alarm condition is advantageously indicated by the red color bar 150 changing to a brightest red illumination and also glowing red, the numerical value 140 changing to solid white, the color of the face 110 border changing to red and the readout background 145 changing to a bright red illumination and also having a red glow. Advantageously, these various visual cues allow a caregiver to quickly recognize the alarming parameter and the severity of the underlying physiological condition of the patient.

FIG. 4 illustrates a parameter gauge 400 presenting an active histogram 410. The histogram has bins 412 evenly distributed around the outer edge of the gauge face 110. The bins 412 are depicted as relatively light, radially extending lines, all of the same length. Bin fill 414 are depicted as relatively dark lines of various lengths coextending with particular ones of the bins 412. The histogram 410 advantageously depicts the amount of time the indicator 120 persists at a given parameter value corresponding to a bin position. The greater amount of time the indicator 120 persists at a given parameter value, the further the histogram fill corresponding to that bin extends from the inner edge to the outer edge of the histogram scale. In an embodiment, the histogram 410 extends the full travel range of the indicator 120.

FIG. 5 illustrates a parameter gauge 500 presenting an alarm limit editor. When a user touches an alarm limit number, e.g. 152 (FIG. 1), the alarm limit number and histogram (if enabled) fades out. These are replaced by a dual knob slider 501. The slider 501 has a decreasing value (relative to the center) left side 510 and an increasing value (relative to the center) right side 520. Accordingly, the slider 501 has a corresponding left side knob 512, left side label 514, right side knob 522 and right side label 524. A user can slide each knob 512, 522 with a finger along a slider carve 550. Each label 514, 524 will track with the corresponding knob 512, 522 position, and the value depicted on each label 514, 524 will update as the corresponding knob is moved. The color (red) alarm bars also track and move with the knobs 512, 522. The between-the-knobs carve portion 555 is also colored (black) so as to help identify the knob positions. Half gauges, such as 101 (FIG. 1) and 103 (FIG. 1) having a single (decreasing or increasing) range have a single knob and label accordingly.

FIGS. 6-9 each illustrate various other parameter gauge embodiments. FIG. 6 illustrates a parameter gauge 600 having a gauge face 110 with an apparent edge 610 so as to appear three-dimensional. FIG. 7 illustrates a parameter gauge 700 with an indicator 120 that sits atop a visible needle 125. The needle 125 and corresponding indicator 120 rotate about a gauge center 113. FIG. 8 illustrates a quarter-circle parameter gauge 800, i.e. a gauge without a ghost face 190 (FIG. 1) to indicate an inactive gauge portion. FIG. 9 illustrates a parameter gauge 900 having only red zone alarm regions 150, 160, i.e. without cautionary yellow zone regions 170, 180 (FIG. 1).

A physiological monitor gauge panel has been disclosed in detail in connection with various embodiments. These embodiments are disclosed by way of examples only and are not to be construed as limiting the scope of the claims that follow. One of ordinary skill in the art will appreciate many variations and modifications.

Embodiments of the present disclosure include a portable or other multi-parameter patient monitor capable of determining multiple physiological parameters from one or more signals output from one or more light sensitive detectors capable of detecting light attenuated by body tissue carrying pulsing blood. For example, in an embodiment, the monitor advantageously and accurately determines a wide variety of physiological parameters or other calculations as discussed above.

In an embodiment, the display of patient monitor advantageously includes a plurality of display modes enabling more parameter data to be displayed than the available physical display real estate. For example, the patient monitor may include one or more user input keys capable of toggling through measurement data. In an embodiment, the displays include mode indicators providing caregivers easily identifiable visual queues, such as LED's, text, icons, or other indicia providing readily identifiable queues as to which parameter is being displayed. In an embodiment, the display may shift, may be parameter color-coded, or the like to further ensure quick comprehension of which measured parameter is the displayed parameter. For example, in an embodiment, the monitor displays SpO₂ in white, pulse rate (BPM) in green, HbCO in orange, and HbMet in blue when the respective measured parameter is within a “normal” range.

In an embodiment, the patient monitor provides an indication that the caregiver should change display modes to view more critical or time sensitive measured parameters, specific caregiver selected parameters, or the like. For example, the patient monitor may advantageously sound audio or visual alarms that alert the caregiver to particular one or more of worsening parameters, parameters changing in a predetermined pattern or rate, parameters stabilizing below user defined or safe thresholds, caregiver selected parameters, or the like. The monitor may also use alerts that provide audio or visual indications of the severity of the condition, severity of the change, or the like. In alternative embodiments, the patient monitor may automatically change display modes when a particular parameter crosses one or more thresholds. For example, a patient monitor may be displaying a first parameter, such as a plethysmograph, and upon determining measurements indicating that HBMet is trending toward an alarm condition, the monitor may automatically switch from displaying the first parameter to the alarming parameter, or in this case, a trend of the alarming parameter.

In an embodiment, a switch is provided to allow a user to switch displays to view an alarming measurement. In an embodiment, during an alarm condition, a parameter display may switch to a trend graph in the same or different color, line weight, flash, flash rate, intensity, size, or the like.

The patient monitor may also include one or more displays capable of displaying trend data for any one or more of the monitored or derived patient parameters. For example, the trend data may be displayed in graph form, may include multiple trend lines, each representing a different monitored or derived patient parameter. Moreover, each trend line may be color-coded to facilitate quick comprehension of which trend line represents which measured parameter. However, an artisan will recognize from the disclosure herein a large number of identification techniques including color-coding, identifying text, or the like. Additionally, user input may toggle displayed trend data, may select which parameters to display simultaneously, or the like.

In an embodiment, the patient monitor includes an audible or visual indication of a type of sensor communicating with the monitor. For example, the patient monitor may provide a particular audio or visual indication, such as a beep, LED activation, graphic activation, text messages, voice messages, or the like, to indicate communication with or connection to an approved sensor, patient cable, combination, or the like. In an embodiment, the indication may change based on the manufacturer, type of sensor recognized or not recognized, type of patient, type of physiological parameters measurable with the attached sensor, or the like. Additional embodiments include an indication of perfusion in the tissue of the measurement site and an indication of the confidence the signal processing has in its output measurements or input signal quality.

To facilitate an understanding of the disclosure, the remainder of the description references exemplary embodiments illustrated in the drawings. Moreover, in this application, reference is made to many blood parameters. Some references that have common shorthand designations are referenced through such shorthand designations. For example, as used herein, HbCO designates carboxyhemoglobin, HbMet designates methemoglobin, and Hbt designates total hemoglobin. Other shorthand designations such as COHb, MetHb, and tHb are also common in the art for these same constituents. These constituents are generally reported herein in terms of a percentage, often referred to as saturation, relative concentration or fractional saturation. Total hemoglobin is generally reported as a concentration in g/dL. The use of the particular shorthand designators presented in this application does not restrict the term to any particular manner in which the designated constituent is reported.

FIG. 10 illustrates a block diagram of an exemplary embodiment of a patient monitoring system 1100. As shown in FIG. 10, the system 1100 includes a patient monitor 1102 comprising a processing board 1104 and a host instrument 1108. The processing board 1104 communicates with a sensor 1106 to receive one or more intensity signal(s) indicative of one or more parameters of tissue of a patient. The processing board 1104 also communicates with a host instrument 1108 to display determined values calculated using the one or more intensity signals. According to an embodiment, the board 1104 comprises processing circuitry arranged on one or more printed circuit boards capable of installation into the monitor 1102, or capable of being distributed as some or all of one or more OEM components for a wide variety of host instruments monitoring a wide variety of patient information. In an embodiment, the processing board 1102 comprises a sensor interface 1110, a digital signal processor and signal extractor (“DSP” or “processor”) 1112, and an instrument manager 1114. In general, the sensor interface 1110 converts digital control signals into analog drive signals capable of driving sensor emitters, and converts composite analog intensity signal(s) from light sensitive detectors into digital data.

In an embodiment, the sensor interface 1110 manages communication with external computing devices. For example, in an embodiment, a multipurpose sensor port (or input/output port) is capable of connecting to the sensor 1106 or alternatively connecting to a computing device, such as a personal computer, a PDA, additional monitoring equipment or networks, or the like. When connected to the computing device, the processing board 1104 may upload various stored data for, for example, off-line analysis and diagnosis. The stored data may comprise trend data for any one or more of the measured parameter data, plethysmograph waveform data acoustic sound waveform, or the like. Moreover, the processing board 1104 may advantageously download from the computing device various upgrades or executable programs, may perform diagnosis on the hardware or software of the monitor 1102. In addition, the processing board 1104 may advantageously be used to view and examine patient data, including raw data, at or away from a monitoring site, through data uploads/downloads, or network connections, combinations, or the like, such as for customer support purposes including software maintenance, customer technical support, and the like. Upgradable sensor ports are disclosed in copending U.S. application Ser. No. 10/898,680, filed on Jul. 23, 2004, titled “Multipurpose Sensor Port”.

As shown in FIG. 10, the digital data is output to the DSP 1112. According to an embodiment, the DSP 1112 comprises a processing device based on the Super Harvard ARChitecture (“SHARC”), such as those commercially available from Analog Devices. However, a skilled artisan will recognize from the disclosure herein that the DSP 1112 can comprise a wide variety of data and/or signal processors capable of executing programs for determining physiological parameters from input data. In particular, the DSP 1112 includes program instructions capable of receiving multiple channels of data related to one or more intensity signals representative of the absorption (from transmissive or reflective sensor systems) of a plurality of wavelengths of emitted light by body tissue. In an embodiment, the DSP 1112 accepts data related to the absorption of eight (8) wavelengths of light, although an artisan will recognize from the disclosure herein that the data can be related to the absorption of two (2) to sixteen (16) or more wavelengths.

FIG. 10 also shows the processing board 1104 including the instrument manager 1114. According to an embodiment, the instrument manager 1114 may comprise one or more microcontrollers controlling system management, including, for example, communications of calculated parameter data and the like to the host instrument 1108. The instrument manager 1114 may also act as a watchdog circuit by, for example, monitoring the activity of the DSP 1112 and resetting it when appropriate.

The sensor 1106 may comprise a reusable clip-type sensor, a disposable adhesive-type sensor, a combination sensor having reusable and disposable components, or the like. Moreover, an artisan will recognize from the disclosure herein that the sensor 1106 can also comprise mechanical structures, adhesive or other tape structures, Velcro wraps or combination structures specialized for the type of patient, type of monitoring, type of monitor, or the like. In an embodiment, the sensor 1106 provides data to the board 1104 and vice versa through, for example, a patient cable. An artisan will also recognize from the disclosure herein that such communication can be wireless, over public or private networks or computing systems or devices, or the like.

As shown in FIG. 10, the sensor 1106 includes a plurality of emitters 1116 irradiating the body tissue 1118 with differing wavelengths of light, and one or more detectors 1120 capable of detecting the light after attenuation by the tissue 1118. In an embodiment, the emitters 1116 comprise a matrix of eight (8) emission devices mounted on a flexible substrate, the emission devices being capable of emitting eight (8) differing wavelengths of light. In other embodiments, the emitters 1116 may comprise twelve (12) or sixteen (16) emitters, although other numbers of emitters are contemplated, including two (2) or more emitters. As shown in FIG. 10, the sensor 1106 may include other electrical components such as, for example, a memory device 1122 comprising an EPROM, EEPROM, ROM, RAM, microcontroller, combinations of the same, or the like. In an embodiment, other sensor components may include a temperature determination device 1123 or other mechanisms for, for example, determining real-time emission wavelengths of the emitters 1116.

The memory 1122 may advantageous store some or all of a wide variety data and information, including, for example, information on the type or operation of the sensor 1106; type or identification of sensor buyer or distributor or groups of buyer or distributors, sensor manufacturer information, sensor characteristics including the number of emitting devices, the number of emission wavelengths, data relating to emission centroids, data relating to a change in emission characteristics based on varying temperature, history of the sensor temperature, current, or voltage, emitter specifications, emitter drive requirements, demodulation data, calculation mode data, the parameters for which the sensor is capable of supplying sufficient measurement data (e.g., HpCO, HpMet, HbT, or the like), calibration or parameter coefficient data, software such as scripts, executable code, or the like, sensor electronic elements, whether the sensor is a disposable, reusable, multi-site, partially reusable, partially disposable sensor, whether it is an adhesive or non-adhesive sensor, whether the sensor is a reflectance, transmittance, or transreflectance sensor, whether the sensor is a finger, hand, foot, forehead, or ear sensor, whether the sensor is a stereo sensor or a two-headed sensor, sensor life data indicating whether some or all sensor components have expired and should be replaced, encryption information, keys, indexes to keys or hash functions, or the like, monitor or algorithm upgrade instructions or data, some or all of parameter equations, information about the patient, age, sex, medications, and other information that may be useful for the accuracy or alarm settings and sensitivities, trend history, alarm history, or the like. In an embodiment, the monitor may advantageously store data on the memory device, including, for example, measured trending data for any number of parameters for any number of patients, or the like, sensor use or expiration calculations, sensor history, or the like.

FIG. 10 also shows the patient monitor 1102 including the host instrument 1108. In an embodiment, the host instrument 1108 communicates with the board 1104 to receive signals indicative of the physiological parameter information calculated by the DSP 1112. The host instrument 1108 preferably includes one or more display devices 1124 capable of displaying indicia representative of the calculated physiological parameters of the tissue 1118 at the measurement site. In an embodiment, the host instrument 1108 may advantageously comprise a handheld housing capable of displaying one or more of a pulse rate, plethysmograph data, perfusion quality such as a perfusion quality index (“PI™”), signal or measurement quality (“SQ”), values of blood constituents in body tissue, including for example, SpO₂, HbCO, HbMet, Hbt, or the like. In other embodiments, the host instrument 1108 is capable of displaying values for one or more of Hbt, Hb, blood glucose, bilirubin, or the like. The host instrument 1108 may be capable of storing or displaying historical or trending data related to one or more of the measured values, combinations of the measured values, plethysmograph data, or the like. The host instrument 1108 also includes an audio indicator 1126 and user input device 1128, such as, for example, a keypad, touch screen, pointing device, voice recognition device, or the like.

In still additional embodiments, the host instrument 1108 includes audio or visual alarms that alert caregivers that one or more physiological parameters are falling below predetermined safe thresholds. The host instrument 1108 may include indications of the confidence a caregiver should have in the displayed data. In a further embodiment, the host instrument 1108 may advantageously include circuitry capable of determining the expiration or overuse of components of the sensor 1106, including, for example, reusable elements, disposable elements, or combinations of the same.

Although described in terms of certain embodiments, other embodiments or combination of embodiments will be apparent to those of ordinary skill in the art from the disclosure herein. For example, the monitor 1102 may comprise one or more monitoring systems monitoring parameters, such as, for example, vital signs, blood pressure, ECG or EKG, respiration, glucose, bilirubin, or the like. Such systems may combine other information with intensity-derived information to influence diagnosis or device operation. Moreover, the monitor 1102 may advantageously include an audio system, preferably comprising a high quality audio processor and high quality speakers to provide for voiced alarms, messaging, or the like. In an embodiment, the monitor 1102 may advantageously include an audio out jack, conventional audio jacks, headphone jacks, or the like, such that any of the display information disclosed herein may be audiblized for a listener. For example, the monitor 1102 may include an audible transducer input (such as a microphone, piezoelectric sensor, or the like) for collecting one or more of heart sounds, lung sounds, trachea sounds, or other body sounds and such sounds may be reproduced through the audio system and output from the monitor 1102. Also, wired or wireless communications (such as Bluetooth or WiFi, including IEEE 801.11a, b, or g), mobile communications, combinations of the same, or the like, may be used to transmit the audio output to other audio transducers separate from the monitor 1102.

For example, patterns or changes in the continuous noninvasive monitoring of intensity-derived information may cause the activation of other vital sign measurement devices, such as, for example, blood pressure cuffs.

FIG. 11 illustrates a perspective view of an exemplary handheld noninvasive multi-parameter patient monitor 1200, such as, for example, the patient monitor 1102 of FIG. 11. Patient monitors 1200 exhibiting combinations of many of the features described herein are advantageously commercially available from Masimo under the brand name “Rad 57c.” As shown in FIG. 10, the monitor 1200 includes a patient cable connector 1202 capable of mechanical mating with a patient cable to establish communication between the board 1104 and the sensor 1106. In an embodiment, the connector 1202 comprises a multipurpose cable connector such as that disclosed in U.S. application Ser. No. 10/898,680, titled “Multipurpose Sensor Port,” disclosing communication between the board 1104 and an external computing device.

The monitor 1200 also comprises a HbCO indicator 1204 advantageously providing a visual queue that a HbCO capable sensor is properly connected through the connector 1202. For example, the HbCO indicator 1204 may advantageously activate when a sensor is connected that communicates sufficient information to determine HbCO, such as, for example, a sensor capable of emitting sufficient different wavelengths of light, a sensor storing sufficient data on the memory 1122, a sensor having appropriate encryption data or key, combinations of the same, or the like. For example, in an embodiment, the processor 1112 may receive information from a memory 1122 indicating a number of available LED wavelengths for the attached sensor. Based on the number of wavelengths, or other information stored on the memory 1122, the processor 1112 may determine whether an HbCO-ready sensor has been attached to the monitor 1200. An artisan will also recognize from the disclosure herein that the HbCO indicator 1204 may advantageously comprise a HbMet indicator, Hbt indicator, or the like, which activates to a predetermined color associated with a parameter, or any color, or deactivates the same, to convey a type of attached sensor. Moreover, the artisan will recognize from the disclosure herein other parameters that may use other sensor components and the monitor 1200 may include indicators capable of indicating communication with those types of sensors.

In an embodiment, the monitor 1200 may also audibly indicate the type of sensor connected. For example, the monitor 1200 may emit predetermined number or frequency of beeps associated with recognition of a particular sensor, a particular manufacturer, failure to recognize the sensor, or the like. Moreover, the sensor type may be indicative of the componentry, such as, for example, whether the sensor produces sufficient data for the determination of HbCO, HbMet, Hbt and SpO₂, SpO₂ only, SpO₂ and HbMet, any combination of the foregoing or other parameters, or the like. Additionally, the sensor type may be indicative of specific sensors designed for a type of patient, type of patient tissue, or the like. In other embodiments, the monitor 1200 may announce the type of connector through speaker 1236.

An artisan will also recognize from the disclosure herein that other mechanical (such as keys), electrical, or combination devices may inform the monitor 1200 of the type of attached sensor. In an embodiment, the processor 1112 also may select to drive less emitters that are currently available, such as, for example, in the presence of low noise and when power consumption is an issue.

The monitor 1200 also comprises a multi-mode display 1206 capable of displaying, for example, measurements of SpO₂ and HbCO (or alternatively, HbMet). In an embodiment, the display 1206 has insufficient space or display real estate to display the many parameters capable of being measured by the monitor 1200. Thus, the multi-mode display 1206 may advantageously cycle through two or more measured parameters in an area common to both parameters even when shifted. In such embodiments, the monitor 1200 may also advantageously include parameter indicators 1208, 1210, providing additional visual queues as to which parameter is currently displayed. In an embodiment, the display may also cycle colors, flash rates, or other audio or visual queues providing readily identifiable information as to which measured parameter is displayed. For example, when the multi-mode display 1206 displays measured values of SpO₂ that are normal, the numbers may advantageously appear in green, while normal measured values of HbCO may advantageously appear in orange, and normal measured values of HbMet may appear in blue. Moreover, in an embodiment, the display 1206 flashes at a predefined rate when searching for saturation and at another predefined rate when a signal quality is below a predetermined threshold.

The monitor 1200 also comprises a HbCO bar 1212 where in an embodiment a plurality of LED's activate from a bottom toward a top such that the bar “fills” to a level proportional to the measured value. For example, the bar 1212 is lowest when the dangers from carbon monoxide poisoning are the least, and highest when the dangers are the greatest. The bar 1212 includes indicia 1214 that provide an indication of the severity of carbon monoxide saturation in a patient's blood. As shown in FIG. 11, the bar 1212 and the indicia 1214 continuously indicate the concentration of HbCO in about 5% increments. The indicia 1214 indicate a measurement of HbCO saturation percentage between about 0 and about 50% with a granularity of about 5%. However, an artisan will also recognize from the disclosure herein a wide variety of ranges and granularities could be used, the indicia 1214 could be electronically displayed in order to straightforwardly increase or decrease resolution, or the like. For example, HbCO may advantageously be displayed with greater resolution than ±about %5 in a lower portion of the scale. For example, an HbCO bar may advantageously include a scale of about <3%, about 6%, about 9%, about 12%, about 15%, about 20%, about 25%, about 30%, about 35%, and about >40%.

As is known in the art, carbon monoxide in the blood can lead to serious medical issues. For example and depending upon the particular physiology of a patient, about 10% carbon monoxide saturation can lead to headaches, about 20% can lead to throbbing headaches, or dyspnea on exertion, about 30% can lead to impaired judgment, nausea, dizziness and/or vomiting, visual disturbance, or fatigue, about 40% can lead to confusion and syncope, and about 50% and above can lead to comas, seizures, respiratory failure and even death.

In an embodiment, the bar 1212 is the same or similar color as the multi-mode display 1206 when displaying HbCO. In other embodiments, the bar 1212 is lowest and green when the dangers from carbon monoxide poisoning are the least, and highest and red when the dangers are the greatest. In an embodiment, as HbCO increases, the entire bar 1212 may advantageously change color, such as, for example, from green to red, to provide a clear indication of deepening severity of the condition. In other embodiments, the bar 1212 may advantageously blink or flash, an audio alarm may beep or provide a continuation or rise in pitch or volume, or the like to alert a caregiver of deepening severity. Moreover, straightforward to complex alarm rules may be implemented to reduce false alarms based on, for example, knowledge of the physiological limitations on the rate of change in HbCO or the like.

Additionally, the monitor 1200 may be capable of storing and outputting historical parameter data, display trend traces or data, or the like. Although the foregoing bar 1212 has been described in terms of certain preferred embodiments, other embodiments will be apparent to those of ordinary skill in the art from the disclosure herein.

FIG. 11 also shows the monitor 1200 including a pulse display 1216 displaying measured pulse rate in beats per minute (“BPM”). In an embodiment, the display 1212 flashes when searching for a pulse. The pulse display 1216 advantageously displays measured pulse rates from about zero (0) to about two hundred and forty (240) BPM. Moreover, when the measured pulse rates are considered normal, the pulse display 1216 is advantageously green. Similar to other displays associated with the monitor 1200, the pulse display 1216 may employ a variety of color changes, audio alarms, or combinations of the same to indicate measured BPM below predetermined safe thresholds. In an embodiment, the pulse rate display 1216 displays the measured pulse rate during the display of SpO₂ and displays message data during the display of other parameters. For example, during the display of HbCO, the display 1216 may advantageously display the term “CO.” In an embodiment, the display of the message data may be in the same or similar color as the other displays. For example, in an embodiment, the multi-mode display 1206, the bar 1212, and the pulse display 1216 may all display data or messages in orange when the multi-mode display 1206 displays measured HbCO values.

FIG. 11 also illustrates the monitor 1200 comprising user input keys 1218, including a HbCO button 1220, mode/enter button 1222, next button 1224, power on/off button 1226, up/down button 1228, and alarm silence button 1230. In an embodiment, activation of the HbCO button 1220 toggles the measured value displayed in the multi-mode display 1206. For example, activation of the HbCO button 1220 toggles the multi-mode display 1206 from displaying measured values of SpO₂ to HbCO for about ten (10) seconds. Activation of the mode/enter button 1222 or the next button 1224 during the ten (10) second period returns the multi-mode display 1206 back to SpO₂. A skilled artisan will also recognize that activation of the HbCO button 1220 may advantageously toggle through a plurality of measured values, and that such values may be displayed for short segments and then return to SpO₂, may remain displayed until further activation of the button 1220, or the like.

Activation of the mode/enter button 1222 cycles through various setup menus allowing a caregiver to select or activate certain entries within the menu setup system, including alarm threshold customizations, or the like. Activation of the next button 1224 can move through setup options within the menu setup system and in an embodiment is not active during normal patient monitoring. For example, a caregiver may activate the mode/enter button 1222 and the next button 1224 to specify high and low alarm thresholds for one or more of the measured parameters, to specify device sensitivity, trend settings, display customizations, color code parameters, or the like. In an embodiment, the high alarm setting for SpO₂ can range from about two percent (2%) to about one hundred percent (100%) with a granularity of about one percent (1%). The low alarm setting for SpO₂ can range from about one percent (1%) to about one hundred percent (100%) with a granularity of about one percent (1%). Moreover, the high alarm setting for pulse rate can range from about thirty (30) BPM to about two hundred and forty (240) BPM with a granularity of about five (5) BPM. The low alarm setting for pulse rate can range from about twenty five (25) BPM to about two hundred and thirty five (235) BPM with a granularity of about five (5) BPM. Other high and low ranges for other measured parameters will be apparent to one of ordinary skill in the art from the disclosure herein.

In a further embodiment, a caregiver may activate the mode/enter button 1222 and the next button 1224 to specify device sensitivity, such as, for example, device averaging times, probe off detection, whether to enable fast saturation calculations, or the like. Various embodiments of fast saturation calculations are disclosed in U.S. patent application Ser. No. 10/213,270, filed Aug. 5, 2002, titled “Variable Indication Estimator”. Using the menus, a caregiver may also advantageously enter appropriate information governing trend collection on one or more of the measured parameters, input signals, or the like.

FIG. 11 also shows the power on/off button 1226. Activation of the power on/off button 1226 activates and deactivates the monitor 1200. In an embodiment, press-and-hold activation for about two (2) seconds shuts the monitor 1200 off. In an additional embodiment, activation of the on/off button 1226 advantageously initiates detection of a type of attached sensor. For example, activation of the on/off button 1226 may advantageously cause the monitor 1200 to read information from a memory on an attached sensor and determine whether sufficient wavelengths exist on the sensor to determine one or more the physiological parameters discussed in the foregoing.

An artisan will recognize from the disclosure herein that the on/off button 1226 may advantageously cause an electronic determination of whether to operate in at powers consisted with the U.S. (60 Hz) or another nationality (50 Hz). In an embodiment, such automatic determination and switching is removed from the monitor 1200 in order to reduce a likelihood of problematic interfering crosstalk caused by such power switching devices.

Activation of the up/down button 1228 may advantageously adjust the volume of the pulse beep tone. Additionally, activation of the up/down button 1228 within the menu setup system, causes the selection of values with various menu options.

Moreover, activation of the alarm silence button 1230 temporarily silences audio alarms for a predetermined period, such as, for example, about one hundred and twenty (120) seconds. A second activation of the alarm silence button 1230 mutes (suspends) the alarm indefinitely, while a third activation returns the monitor 1200 to standard alarm monitoring. FIG. 11 also shows the alarm silence button 1230 includes an alarm silenced indicator 1232. The alarm silenced indicator 1232 may advantageously flash to indicate one or more alarms are temporarily silenced, may illuminate solid to indicate the alarms have been muted, or the like. Moreover, an artisan will recognize from the disclosure herein a wide variety of alarm silencing methodologies.

The monitor 1200 also includes a battery level indicator 1234 indicating remaining battery life. In the illustrated embodiment, four LED's indicate the status of the battery by incrementally deactivating to indicate proportionally decreasing battery life. In an embodiment, the four LED's may also change color as the battery charge decreases, and the final LED may begin to flash to indicate that the caregiver should replace the batteries.

FIG. 11 also shows the monitor 1200 including an audio transducer or speaker 1236. The speaker 1236 advantageously provides audible indications of alarm conditions, pulse tone and feedback for key-presses, or the like. Moreover, the monitor 1200 includes a low signal quality indicator (“SQ” or “SIQ™”) 1238. The signal IQ indicator 1238 activates to inform a caregiver that a measured value of the quality of the incoming signal is below predetermined threshold values. For example, in an embodiment, the measured value for signal IQ is at least partially based on an evaluation of the plethysmograph data's correspondence to predetermined models or characteristics of physiological signals. In an embodiment, the signal IQ indicator 1238 output may be associated with the displayed parameter. For example, the output may be associated with one threshold for the display of SpO₂ and another for the display of other parameter data.

The monitor 1200 also comprises a perfusion quality index (PI™) bar 1240 (which quantifies the measure of perfusion of the patient) where in an embodiment a plurality of LED's activate from a bottom toward a top such that the bar “fills” to a level proportional to the measured value. In one embodiment, the PI™ bar 1240 shows a static value of perfusion for a given time period, such as, for example, one or more pulses. In another embodiment, or functional setting, the PI™ bar 1240 may advantageously pulse with a pulse rate, may hold the last reading and optionally fade until the next reading, may indicate historical readings through colors or fades, or the like. Additionally, the PI™ bar 1240 may advantageously change colors, flash, increasingly flash, or the like to indicate worsening measured values of perfusion.

The PI™ bar 1240 can be used to simply indicate inappropriate occlusion due, for example, to improper attachment of the sensor 1106. The PI™ bar 1240 can also be used as a diagnostic tool during low perfusion for the accurate prediction of illness severity, especially in neonates. Moreover, the rate of change in the PI™ bar 1240 can be indicative of blood loss, sleep arousal, sever hypertension, pain management, the presence or absence of drugs, or the like. According to one embodiment, the PI™ bar 1240 values may comprise a measurement of the signal strength of the arterial pulse as a percentage of the total signal received. For example, in one preferred embodiment, the alternating portion of at least one intensity signal from the sensor 1106 may advantageously be divided by the static portion of the signal. For example, an infrared intensity signal may advantageously be used as it is less subjective to noise.

In an embodiment, a measurement below about 1.25% may indicate medical situations in need of caregiver attention, specifically in monitored neonates. Because of the relevance of about 1.25%, the PI™ bar 1240 may advantageously include level indicia 1242 where the indicia 1242 swap sides of the PI™ bar 1240, thus highlighting any readings below about that threshold. Moreover, behavior of the PI™ bar 1240, as discussed above, may advantageously draw attention to monitored values below such a threshold.

As discussed above, the monitor 1200 may include output functionality that outputs, for example, trend perfusion data, such that a caregiver can monitor measured values of perfusion over time. Alternatively or additionally, the monitor 1200 may display historical trace data on an appropriate display indicating the measured values of perfusion over time. In an embodiment, the trend data is uploaded to an external computing device through, for example, the multipurpose sensor connector 1200 or other input output systems such as USB, serial or parallel ports or the like.

The monitor 1200 also includes an alarm indicator 1244 capable of providing visual queues of the status of one or more of the measured parameters. For example, the alarm indicator 1244 may advantageously be green when all of the measured parameters are within normal conditions, may gradually fade to red, may flash, increasing flash, or the like, as one or more of the measured values approaches or passes predetermined thresholds. In an embodiment, the alarm indicator 1244 activates when any parameter falls below an associated threshold, thereby advantageously informing a caregiver that perhaps a nondisplayed parameters is at an alarm condition. In another embodiment, the alarm indicator 1244 may indicate the status of the parameter displayed on the multi-mode display 1206. In an embodiment, the speaker 1236 may sound in conjunction with and/or in addition to the indicator 1244. Moreover, in an embodiment, an alarming parameter may automatically be displayed, may be emphasized, flashed, colored, combinations of the same or the like to draw a user's attention to the alarming parameter.

Although the foregoing invention has been described in terms of certain preferred embodiments, other embodiments will be apparent to those of ordinary skill in the art from the disclosure herein.

FIG. 12 illustrates an exemplary display of the patient monitor 1200. As shown in FIG. 12, the display includes the multi-mode display 1206, the pulse rate display 1216, parameter indicators 1208, 1210, the HbCO bar 1212 and indicator 1204, the PI™ bar 1240, and the alarm indicator 1244. In an embodiment, the multi-mode display 1206 and the pulse rate display 1216 each comprise a plurality of seven segment displays 1302 capable of displaying alpha-numeric information. As disclosed in the foregoing, the exemplary display may advantageously include color-coded parameter displays. Moreover, the exemplary display may include color progressions, flashing, flashing progressions, audible alarms, audible progressions, or the like, indicating worsening measured values of physiological data. In addition, in an embodiment, some or all of the displays may flash at a first rate to indicate attempts to acquire data when actual measured values are unavailable. Moreover, some or all of the display may flash at a second rate to indicate low signal quality where confidence is decreasing that the measured values reflect actual physiological conditions.

FIG. 13 illustrates the display of FIG. 12 showing measured values of SpO₂, BPM, perfusion, and type of sensor, according to an exemplary embodiment of the patient monitor of FIG. 10. As shown in FIG. 13, the multi-mode display 1206 is displaying a percentage value of SpO₂, and the pulse rate display 1216 is displaying a pulse rate in beats per minute. Accordingly, the parameter indicator 1210 is activated to confirm the display of measured values of SpO₂. As disclosed in the foregoing, in an embodiment, the multi-mode display 1206 is red, indicating blood oxygen measurements while the pulse rate display 1216 is green, indicating normal values of a patient's pulse.

FIG. 13 also shows the PI™ bar 1240 almost fully activated, representing good perfusion. In addition, the HbCO indicator 1204 is showing communication with a sensor producing insufficient data to determine measured values of additional parameters, such as, HbCO. In an embodiment, such sensors may comprise sensors capable of emitting light at about two (2) different wavelengths, may comprise sensors with insufficient data stored on a memory associated therewith, or the like.

FIG. 14 illustrates the display of FIG. 12 showing measured values of HbCO, perfusion, and type of sensor, according to an exemplary embodiment of the patient monitor of FIG. 10. As shown in FIG. 14, the multi-mode display 1206 is displaying a percentage value of HbCO, and the pulse rate display 1216 is displaying an appropriate message indicating the HbCO measurement, such as, for example, “CO”. Also, the multi-mode display 1206 has shifted the data to the left to quickly and efficiently indicate that the displayed parameter is other than SpO₂. Accordingly, the parameter indicator 1208 is also activated to confirm the display of measured values of HbCO. As disclosed in the foregoing, in an embodiment, the multi-mode display 1206 and pulse rate display message 1216 are orange.

FIG. 14 also shows the PI™ bar 1240 almost fully activated, representing good perfusion. In addition, the activation of the HbCO indicator 1204 represents communication with a sensor capable of producing sufficient data to determine measured values of HbCO. In an embodiment, such sensors may comprise sensors capable of emitting light at about eight (8) or more different wavelengths; however, such sensors may comprise about two (2) or more different wavelengths. Moreover, such sensors may have appropriate data stored on a memory associated therewith, or the like. FIG. 14 also shows the HbCO measurement being about 20% (as illustrated on the HbCO bar 1212 and multi-mode display 1206) thereby indicating a potentially dangerous situation that if exacerbated, will become quite problematic. Therefore, the alarm indicator 1244 is also activated, and in some embodiments, the speaker 1236 as well.

FIG. 15 illustrates the display of FIG. 12 showing measured values of SpO₂, HbCO, BPM, perfusion, and type of sensor, according to an exemplary embodiment of the patient monitor of FIG. 10. In contrast to FIG. 13, FIG. 15 shows that the monitor 1200 is communicating with a sensor capable of producing sufficient data to determine measured values of HbCO, even though the displayed values are that of SpO₂ and BPM. Thus, FIG. 15 shows the activation of the HbCO indicator 1204, and the continuous monitoring of HbCO by the HbCO bar 1212. FIG. 15 also shows a high value of HbCO, and therefore, the indication of an alarm condition by activation of the alarm indicator 1244. In an embodiment, upon determination of an alarm condition on a nondisplayed parameter, the monitor 1200 may advantageously provide an alarm indication through speaker and alarm indicator activation, automatic toggle to the nondisplayed parameter on the multi-mode display 1206 for a defined or undefined time, or the like.

FIG. 16 illustrates a top elevation view of an exemplary handheld noninvasive multi-parameter patient monitor 1700 capable of displaying at least HbCO and HbMet, such as, for example, the patient monitor of FIG. 10. Patient monitors exhibiting combinations of many of the features described herein are advantageously commercially available from Masimo under the brand name “Rad 57 cm.” As shown in FIG. 16, the monitor 1700 comprises a monitor similar to monitor 1200 disclosed with reference to FIG. 11. Moreover, monitor 1700 further includes a multi-mode display 1706 capable of displaying, for example, measurements of HbMet and BPM. In an embodiment, the display 1706 has insufficient space or display real estate to display the many parameters capable of being measured by the monitor 1700. Thus, the multi-mode display 1706 may advantageously cycle through two or more measured parameters. In such embodiments, the monitor 1700 may also advantageously include parameter indicators 1708, 1710, providing additional visual queues as to which parameter is currently displayed. In an embodiment, the display 1706 may also cycle colors, flash rates, or other audio or visual queues providing readily identifiable information as to which measured parameter is displayed. For example, when the multi-mode display 1706 displays measured values of BPM that are normal, the numbers may advantageously appear in green, while normal measured values of HbMet may appear in blue. Moreover, in an embodiment, the display 1706 may flash at a predefined rate when searching for saturation and at another predefined rate when a signal quality is below a predetermined threshold.

FIG. 16 also illustrates the monitor 1700 comprising user input keys 1718, including an HbCO/HbMet button 1220. In an embodiment, activation of the HbCO/HbMet button 1720 toggles the measured value displayed in the multi-mode display 1706. For example, activation of the HbCO/HbMet button 1720 toggles the multi-mode display 1206 from displaying measured values of SpO₂ and BPM, to HbCO and HbMet for about ten (10) seconds. Activation of the mode/enter button 1222 or the next button 1224 during the ten (10) second period returns the multi-mode display 1706 back to SpO₂ and BPM. A skilled artisan will also recognize that activation of the HbCO/HbMet button 1720 may advantageously toggle through a plurality of measured values, and that such values may be displayed for short segments and then return to SpO₂ and BPM, may remain displayed until further activation of the button 1720, or the like.

The monitor 1700 also comprises a coarser indication of HbMet through an HbMet bar 1740. In an embodiment, a plurality of LED's activate from a bottom toward a top such that the bar “fills” to a level proportional to the measured value, with increments at about 0.5%, about 1%, about 2%, about 3%, about 4%, about 5%, about 7.5%, about 10%, about 15% and greater than about 20%, although an artisan will recognize from the disclosure herein other useful delineations. Additionally, the HbMet bar 1740 may advantageously change colors, flash, increasingly flash, or the like to indicate worsening measured values of perfusion.

Although disclosed with reference to the HbMet bar 1740, and artisan will recognize from the disclosure herein other coarse or even gross indications of HbMet, or any measured parameter. For example, a single LED may advantageously show green, yellow, and red, to indicate worsening coarse values of HbMet. Alternatively, a single LED may simply light to indicate an alarm or approaching alarm condition.

FIG. 17 illustrates an exemplary display of the patient monitor 1700 of FIG. 16. As shown in FIG. 17, the display includes the multi-mode displays 1206, 1706, parameter indicators 1208, 1210, 1708, 1710, the HbCO bar 1212 and indicator 1204, the HbMet bar 1740, and the alarm indicator 1244. In an embodiment, the multi-mode display 1706 is similar to multi-mode display 1206, comprising a plurality of seven segment displays 1302 capable of displaying alpha-numeric information, and capable of altering its display characteristics or aspects in a wide variety of configurations discussed with reference to the display 1206.

FIG. 18 illustrates the display of FIG. 17 showing measured values of SpO₂, BPM, HbCO, HbMet, and type of sensor according to an exemplary embodiment of the patient monitor of FIG. 10. FIG. 18 also shows the HbMet bar 1740 near the bottom and corresponding to about 1%, representing acceptable HbMet, while the HbCO bar 1212 hovers at a dangerous near 20%. In addition, the HbCO indicator 1204 is showing communication with a sensor producing sufficient data to determine measured values of additional parameters, such as, HbMet, HbCO or the like. In an embodiment, such sensors may comprise sensors capable of emitting light of more than two (2) different wavelengths, preferably more than four (4) different wavelengths, and more preferably eight (8) or more different wavelengths.

FIG. 19 illustrates the display of FIG. 17 showing measured values of HbCO, HbMet, and type of sensor according to an exemplary embodiment of the patient monitor of FIG. 10. As shown in FIG. 19, the multi-mode display 1706 is displaying a percentage value of HbMet that is shifted using the parameter indicator 1708. The data has been advantageously shifted to the left to quickly and efficiently indicate that the displayed parameter is other than BPM. Accordingly, the parameter indicator 1708 is also activated to confirm the display of measured values of HbMet. As disclosed in the foregoing, in an embodiment, the multi-mode display 1706 is blue.

FIG. 19 also shows the HbMet bar 1740 nearly empty, representing acceptable HbMet. In addition, the activation of the HbCO indicator 1204 represents communication with a sensor capable of producing sufficient data to determine measured values of HbCO. In an embodiment, such sensors may have appropriate data stored on a memory associated therewith, or the like. FIG. 19 also shows the HbCO measurement being about 20% (as illustrated on the HbCO bar 1212 and multi-mode display 1206) thereby indicating a potentially dangerous situation that if exacerbated, will become quite problematic. Therefore, the alarm indicator 1244 is also activated, and in some embodiments, the speaker 1236 as well.

FIG. 20A illustrates a perspective view of an exemplary noninvasive multi-parameter patient monitor 2000, such as, for example, the patient monitor of FIG. 10. Moreover, FIGS. 20B-20E illustrate exemplary display screens of the patient monitor of FIG. 20A. As shown in FIGS. 20A-20B, an embodiment of the monitor 2000 includes a display 2001 showing a plurality of parameter data. For example, the display may advantageously comprise a CRT or an LCD display including circuitry similar to that available on oximeters commercially available from Masimo Corporation of Irvine, Calif. sold under the name Radical, and disclosed in the U.S. patents referenced above. However, an artisan will recognize from the disclosure herein many commercially available display components capable of displaying multiple parameter data along with the ability to display graphical data such as plethysmographs, trend traces, and the like.

In an embodiment, the display includes a measured value of SpO₂ 2002, a measured value of pulse rate 2004 in BPM, a plethysmograph 2006, a measured value of HbCO 2008, a measured value of HbMet 2010, a measured value of a perfusion quality 2012, a measured value of Hbt 2014, and a derived value of fractional saturation “SpaO₂” 2016. In an embodiment, SpaO₂ comprises HbO₂ expressed as a percentage of the four main hemoglobin species, i.e., HbO₂, Hb, HbCO, and HbMet.

In an embodiment, one or more of the foregoing parameter includes trending or prediction indicators showing the current trend or prediction for that corresponding parameter. In an embodiment, the indicators may advantageously comprise an up arrow, a down arrow, and a hyphen bar to indicate up trending/prediction, down trending/prediction, or neutral trending/prediction.

FIG. 20C illustrates an exemplary display screen showing trend graph 2040 including trend line 2042 for HbMet. In an embodiment, the trend line 2042 may be advantageously colored for quick straightforward recognition of the trending parameter, may be associated with any one or more of the foregoing alarm attributes, may include trending lines for other parameters, or the like. The display screen also shows trending directional indicators 2042, 2044 for many of the displayed physiological parameters. In an embodiment, the directional indicators 2042, 2044 may advantageously comprises arrows showing the recent trend, predicted trend, user-customizable trend, combinations thereof, or the like for the associated parameters. In an embodiment, the directional indicators 2042, 2044 comprises an up arrow indicating a rising trend/predicted trend, a middle bar indicating a somewhat stable trend/predicted trend, and a down arrow indicating a lowering trend/predicted trend. An artisan will recognize a wide variety of other directional indicators 2042, 2044 from the disclosure herein.

FIG. 20D shows an exemplary display screen in vertical format. Such vertical format could be user actuated or based on a gravity switch. FIGS. 20E-20F illustrate additional displays of various physiological parameters similar to those discussed in the foregoing. being As shown in FIG. 20G, the display includes a measured value of SpO₂ 2062, a measured value of pulse rate 2064 in BPM, a plethysmograph 2066, a HbCO bar 2068, and a HbMet bar 2070. In an embodiment, the HbCO bar 2068 and HbMet bar 2070 may advantageously behave the same or similarly to the HbCO bar 1212 and HbMet bar 1740. Moreover, similar bars may advantageously display any of the physiological parameters discussed herein using display indicia appropriate to that parameter. For example, a SpO₂ or SpaO₂ bar may advantageously range from about 0% to about 100%, and more preferably range from about 50% to about 100%, while a Hbt bar may advantageously range from about 0 to about 30.

Moreover, similar to the disclosure above, the measured value of SpO₂ 2062 may advantageously toggle to measured values of HbCO, HbMet, Hbt, or the like based on, for example, actuation of user input keys, or the like.

In addition to the foregoing, the display may also include graphical data showing one or more color-coded or other identifying indicia for traces of trend data. Moreover, other graphical presentations may advantageously provide readily identifiable indications of monitored parameters or combinations of monitored parameters of the patient. For example, in an embodiment, the display includes a SpaO₂ graph 2072. The SpaO₂ graph 2072 plots SpO₂ as a function of other blood analytes (1-SpaO₂), where SpaO₂ comprises HbO₂ expressed as a percentage of the four main hemoglobin species, i.e., HbO₂, Hb, HbCO, and HbMet. Thus, as shown in FIG. 20C, as the slope of the displayed line or arrow increases, the caregiver can readily note that the majority of hemoglobin carriers are being used to carry oxygen, and not, for example, harmful carbon monoxide. On the other hand, as the slope decreases, the caregiver can readily and advantageously note that the number of hemoglobin species available to carry oxygen is decreasing, regardless of the current value of SpO₂. Moreover, the length of the arrow or line also provides an indication of wellness, e.g., the higher the line the more oxygen saturation, the lower the line, the more likely there may be desaturation event, or the like.

Thus, the SpaO₂ graph 2072 provides the caregiver with the ability to recognize that even though the measured value of SpO₂ may be within acceptable ranges, there are potentially an unacceptable number of hemoglobin carriers unavailable for carrying oxygen, and that other potential problems may exist, such as, for example, harmful carbon monoxide levels, or the like. In an embodiment, various alarm conditions may cause the graph 2072 to change color, flash, or any combination of alarm indications discussed in the forgoing. Moreover, FIG. 20G illustrates yet an additional display of the foregoing parameters.

An embodiment may also include the monitor 2000 advantageously defining regions of wellness/severity of the monitored patient. For example, because the graph 2072 comprises two dimensions, the monitor 2000 may advantageously define regions where the patient's measured physiological parameters are considered acceptable, regions where the patient is considered at risk, regions where the patient is critical, and the like. For example, one region of acceptability may include a high SpO₂ and a low 1-SpaO₂, another region of risk may include a high SpO₂ and a high 1-SpaO₂, and another critical region may include a low SpO₂ and a high 1-SpaO₂. Moreover, an artisan will recognize from the disclosure herein that different parameters may also be combined to provide readily identifiable indications of patient wellness.

In addition to or as an alternative to the two dimensional SpaO₂ graph 2072, the monitor 2000 may also include a three dimensional graph, such as, for example, extending the graph 2072 along the variable of time. In this embodiment, the forgoing regions advantageously become three dimensional surfaces of wellness. Moreover, trend data may also be advantageously added to the surface to provide a history of when particular monitored parameters dipped in and out of various surfaces of wellness, risk, criticality, or the like. Such trend data could be color-coded, text identified, or the like. An artisan will also recognize that such surfaces may be dynamic. For example, measurements of HbCO>about 5 may dictate that trend data showing SpO₂<about 90% should be considered critical; however, measurements of HbCO<about 5 may dictate only SpO₂<about 85% would be critical. Again, an artisan will recognize from the disclosure herein other parameter combinations to create a wide variety of wellness/critical regions or surfaces that provide readily available visual or audio indications of patient well being, trigger specific alarms, or the like.

Moreover, the monitor 2000 may advantageously employ enlargement or reorganization of parameter data based on, for example, the severity of the measurement. For example, the monitor 2000 may display values for HbCO in a small portion of the screen or in the background, and when HbCO begins to approach abnormal levels, the small portion may advantageously grown as severity increases, even in some embodiments to dominate the display. Such visual alarming can be combined with audio alarms such as announcements, alarms, rising frequencies, or the like, and other visual alarms such as flashing, coloration, or the like to assist a caregiver in noticing the increasing severity of a monitored parameter. In an embodiment, a location of the display of an alarming value is changed to be displayed in a larger display area, such as 2002, so as to be readily noticeable and its display values readily ascertainable.

Although the foregoing invention has been described in terms of certain preferred embodiments, other embodiments will be apparent to those of ordinary skill in the art from the disclosure herein. For example, the monitor 1102 may advantageously be adapted to monitor or be included in a monitor capable of measuring physiological parameters other than those determined through absorption spectroscopy, such as, for example, blood pressure, ECG, EKG, respiratory rates, volumes, inputs for blood pressure sensors, acoustical sensors, and the like. Moreover, the monitor 1102 may be adapted for wireless communication to and from the sensor 1106, and/or to and from other monitoring devices, such as, for example, multi-parameter or legacy monitoring devices. 

What is claimed is:
 1. A noninvasive monitor configured to communicate with a sensor that includes an emitter and one or more detectors, the sensor configured to position the emitter and the one or more detectors proximate to tissue of a patient, the noninvasive monitor comprising: an input configured to receive, from the sensor, a signal that is responsive to detected light from the emitter attenuated by the tissue; and one or more hardware processors configured to process the signal to determine measurement values for a physiological parameter of the patient; and a display configured to present a gauge panel, the gauge panel configured to present a plurality of indicators responsive to the measurement values, the gauge panel comprising: a numerical indicator of the plurality of indicators comprising a numerical readout, the numerical readout being configured to equal one of the measurement values, a gauge face extending from a first side of the numerical readout to a second side of the numerical readout, a plurality of positions along the gauge face being mapped to different parameter values for the physiological parameter ranging from a low parameter value to a high parameter value, a gauge indicator of the plurality of indicators being overlaid on the gauge face, the gauge indicator being located at a position of the plurality of positions that maps to the one of the measurement values, and a graphical histogram indicator disposed along the gauge face and comprising a plurality of bars.
 2. The noninvasive monitor of claim 1, wherein a first bar of the plurality of bars corresponds to a first range of the parameter values and has a first height responsive to an amount of time that the gauge indicator indicated a first portion of the gauge indicator that maps to the first range, and a second bar of the plurality of bars corresponds to a second range of the parameter values different from the first range and has a second height responsive to an amount of time that the gauge indicator indicated a second portion of the gauge indicator different from the first portion that maps to the second range, the first bar being located proximate to the first portion and the second bar being located proximate to the second portion.
 3. The noninvasive monitor of claim 1, wherein in response to a user selection of an area covered by the graphical histogram indicator, the graphical histogram indicator is visually replaced on the gauge panel with a slider configured to receive a user input indicating an input value, the input value being between the low parameter value and the high parameter value.
 4. The noninvasive monitor of claim 1, wherein in response to a user selection of an area covered by the graphical histogram indicator, the graphical histogram indicator is visually replaced on the gauge panel with a slider configured to receive a plurality of user inputs indicating a first input value and a second input value, the first input value and the second input value being between the low parameter value and the high parameter value.
 5. The noninvasive monitor of claim 4, wherein the one or more hardware processors is configured to set a first alarm threshold to the first input value and a second alarm threshold to the second input value.
 6. The noninvasive monitor of claim 4, wherein the slider is a dual knob slider.
 7. The noninvasive monitor of claim 1, wherein an alarm limit value is overlaid on the graphical histogram indicator, the alarm limit value identifying an alarm threshold for the measurement values.
 8. The noninvasive monitor of claim 1, wherein a plurality of alarm limit values are overlaid on the graphical histogram indicator, the plurality of alarm limit values identifying a plurality of alarm thresholds for the measurement values.
 9. The noninvasive monitor of claim 1, wherein the graphical histogram indicator comprises a plurality of bins that have the same length, the plurality of bins having lighter coloring than the plurality of bars and being positioned behind the plurality of bars.
 10. The noninvasive monitor of claim 1, wherein the gauge face is formed as an arc that has a raised center, wherein the plurality of bars are disposed along the arc.
 11. The noninvasive monitor of claim 1, wherein the gauge face is formed as a half circle, wherein the plurality of bars are disposed along the half circle.
 12. The noninvasive monitor of claim 1, wherein the gauge face comprises an alarm bar extending from an end of the gauge face, the alarm bar defining an alarm region for the measurement values.
 13. The noninvasive monitor of claim 1, wherein the physiological parameter comprises total hemoglobin.
 14. The noninvasive monitor of claim 1, wherein the physiological parameter comprises methemoglobin.
 15. The noninvasive monitor of claim 1, wherein the gauge panel comprises a parameter type indicator that indicates one of total hemoglobin, methemoglobin, and oxygen saturation.
 16. The noninvasive monitor of claim 1, wherein a degree to which the gauge indicator is displaced from a vertical position indicates a degree of abnormality of the one of the measurement values.
 17. The noninvasive monitor of claim 1, wherein the gauge face is disposed between the graphical histogram indicator and the numerical indicator.
 18. The noninvasive monitor of claim 1, wherein the gauge face comprises an edge that causes the gauge face to appear three dimensional. 